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Webster, Doris Momhinweg NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital.Records Name First Middle Last Sex Doris Momhinweg Webster Female Date of Death Age If Veteran of U.S.Armed Forces, 02/28/2022 96 Years War or Dates Place of Death Hospital,Institution or City.Town or Village Queensbury Town Street Address 266 Chestnut Ridge Road,Queensbury Town,New York 12804 Manner of Death ©Natural Cause Accident 1:1Homicide El Suicide 0 Undetermined El Pending Circumstances Investigation Medical Certifier Name Title Gerard Abess MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Vale Queensbury 5657 43 NiBurial Date Cemetery,Crematory or Facility Name 03/08/2022 Pine View Cemetery 0 Entombment Address 3 a Cremation Queensbury Town,New York 0 Donation 0 Removal Date Place Removed and/or and/or Held Hold Address • Date Point of ❑Transportation Shipment by Common Carrier Destination DisintermentDate Cemetery Address Reintem>ent Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 'W Remains are Shipped,If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/01/2022 Registrar of Vital Statistics Confine?fiWfegasdc Beefier(tE/ectron>calTySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition ,5=;17•d) Place of Disposition ,7/ A,oKC.ie R 6• .),,r-cr ff xi r q iv1 /`Fro`t ,�,11 (address) 1 /VGA.) 14ull Sore .5 r;)[nC% 1 ion/exton or (tot number) (grave number) :I Name of S Person in Charge of Premi s O n n I �e P-1- (please print) I 11• • Title 7/t p r i m 11r/ c iL Signature DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012920 Receipt tt .. Human remains of i )):. i ,- '- , C :: ---\ -- delivered on .) • ; , 20 7:7 , I Al ,ii, -, ) . - Pike View Cemetery f Representing the funeral home namcd on burial permit -- Official Funeral Directors Reg.or License# 1 , I Webster NAME Doris Mormhinweg Webster Age: 96 Lot Owner: John o & Doris M Webster Lot# New Hudson #3 26 C Grave# 1 Case: Concrete Died: 2.2 8.2 2 Interred: 5.2 7.2 2 Funeral Home: Carleton F1'L Cemetery: Pine View _ .Webster • Lot No. 26C Address RD#1 Chestnut Ridge Road Box 528 Glens Falls, N.Y. 12801 Section No. 3 Dwner John 0. & Dorm M. Webster Plot New Hudson Date 7/28/83 Approx. 100 Superficial ft. @ Location 8em,ndPrt North by nth, South by Colchester, East by White west by path Corner Posts Remarks Deed No. (and changes) 1785 Tranferred From 1019 Payment Record paid in Full 8/8/h7 Record of Interments E PAT 2 .-vh n (2 U. \o%‘t-se 7b7iic PS w -oRiS i&LS l_5 37-oaa lki A T/S M IF(S sl yl � � � I.'' / 2 I 8 Co 1 c hes fie. r N W w E Form No. 01 S